Have you experienced pain ranging from a dull ache to sharp pain in your upper back, and have no idea where it’s coming from?  

Does it get worse when you are sitting and just trying to get your work done?  

Have you been rolling it with a lacrosse ball, trying to release it with a massage gun, and stretching it out like nobody’s business, but to no avail?  

Well, you came to the right place!  

You may be dealing with an increasingly common and painful affliction called Dorsal Scapular Nerve Entrapment (DSN). Today, we are going to talk about what it is, how it presents, and some strategies to help you overcome it. 

Causes of Dorsal Scapular Nerve Entrapment 

While DSN entrapment can feel like a pinched nerve under the shoulder blade, there are several reasons why irritation may develop along the medial border of the scapula, including: 

• Tightness or overactivation in the levator scapulae, rhomboids, or scalenes 

• Weakness or inhibition of the serratus anterior 

• Postural strain from desk work or forward head posture 

• Carrying heavy bags or backpacks 

• Repetitive overhead movements 

• Limited cervical or thoracic mobility 

Dorsal scapular nerve entrapment is considered a rare cause of medial scapular pain and can mimic other sources of upper thoracic or interscapular discomfort (Sharma & Botchu, 2021). When this happens, the nerve can become compressed or irritated, leading to scapular pain, burning, or tension that doesn’t improve with stretching alone. 

Symptoms of Dorsal Scapular Nerve Entrapment

People with DSN irritation often describe: 

• Sharp, aching, or burning nerve pain under the shoulder blade 

• A pulling sensation along the medial border of the scapula 

• Tightness that returns immediately after rolling or stretching 

• Weakness or fatigue during pulling or rowing movements 

• Discomfort that worsens with sitting or poor posture 

• Discomfort taking a big deep breath 

• Localized pain rather than numbness down the arm (which helps differentiate it from cervical radiculopathy) 

These dorsal scapular nerve entrapment symptoms can mimic a rhomboid pinched nerve, but the irritation is often nerve-based rather than purely muscular. 

Role of the Dorsal Scapular Nerve in Muscle Function

The dorsal scapular nerve innervates the rhomboids and levator scapulae, muscles that stabilize and control the scapula (Bishop & Varacallo, 2023). These muscles keep the shoulder blade moving smoothly along the rib cage and support posture.  

When the DSN is irritated:  

• Scapular control may decrease  

• The rhomboids may feel weak or overstretched  

• The levator scapulae may tighten defensively  

• The shoulder blade may begin to “wing,” placing more strain on surrounding tissues  

As a result, DSN irritation often leads to recognizable dorsal scapular nerve pain patterns, especially along the medial border of the scapula. 

How We Treat Dorsal Scapular Nerve Entrapment

When we refer to treating the site of the issue, we mean using modalities such as Active Release Techniques, cupping, and chiropractic care to reduce pain, improve mobility, and stimulate healing. These techniques help calm irritation in the area where many people experience scapula (shoulder blade) pain or nerve entrapment.

In terms of long-term pain relief, we use functional rehabilitation to strengthen weak muscles, giving the overactive muscles a reason not to work so hard. 

For example, when the medial scalene, levator scapula, and rhomboids are holding excessive tone for any reason, this can lead the shoulder blade to be in an improper position along the rib cage. This could take the form of what is called a “winged scapula.” When the scapula is in a winged position, it stretches out the serratus anterior, and when a muscle is stretched out for a prolonged period of time, it will begin to lose its contractility and become weak and even inhibited. 

Our Doctors will work to reduce tension in the muscles and excitability along the DSN, and our Rehab Specialist will work to restore function by restoring activation and strength to the serratus anterior. 

This, in turn, can help improve winging of the scapula and support a more optimal position of the shoulder blade along the rib cage, reducing irritation to the nerve under the shoulder blade and supporting long-term function. 

All working together to help you feel better fast and return back to a life free of limitations. 

Exercises To Consider

• Serratus Slides 
• Serratus Punch 
• Serratus Circles 
• Floor Overhead Shoulder Flexion 

1. How do I know if my pain is from dorsal scapular nerve entrapment?
   Many people describe scapular pain or a pinched nerve in the shoulder blade, especially along the medial border of the scapula. Symptoms often include sharp or burning nerve pain under the shoulder blade with no tingling down the arm. In other occasions, patients report “deep muscles soreness” but stretching and massaging those muscles do not relieve symptoms.
2. Why doesn’t stretching help?
   The issue is often an actual nerve entrapment at the shoulder blade. Stretching may loosen the muscles, but it doesn’t correct the mechanics causing irritation of the nerve under the scapula or the rhomboid, resulting in a pinched-nerve feeling.
3. What treatments work best?
   Hands-on care helps calm irritation along the medial border of the scapula, where many people feel a trapped nerve. Rehab then strengthens the serratus anterior to reduce long-term pressure and improve shoulder blade control.
4. How long does recovery take?
   It depends on how irritated the nerve is. People with mid-scapular pain or tingling under the shoulder blade may experience improvement quickly. In contrast, long-standing dorsal scapular nerve pain patterns may take longer to resolve. Your doctor should have a clear picture of your symptoms and your specific goals and prescribe a plan that makes sense to you.
5. Can it come back?
   Yes, especially if the serratus anterior stays weak or the levator scapulae remains overactive. Since the dorsal scapular nerve innervates the rhomboids, improving scapular strength helps reduce recurring pinched nerve under scapula symptoms. Identifying underlying patterns is essential for long term success and symptom management. Patients at Tangelo have amazing outcomes for DSN.

Start Your Recovery Journey

If you feel that you are currently experiencing dorsal scapular nerve entrapment, the best thing you can do is get it assessed and treated right away. 

The longer you wait, the longer it may take to recover and the more time you could spend feeling limited. 

We have 2 Seattle locations (West Seattle and Green Lake) and 1 Portland location to serve you. 

Give us a call or submit an appointment request today! 

References 

Sharma, G. K., & Botchu, R. (2021). Dorsal scapular nerve entrapment neuropathy managed by ultrasound-guided hydrodissection – a case report. Journal of Ultrasonography, 21(84), 74–76. https://pmc.ncbi.nlm.nih.gov/articles/PMC8008197/ 

Bishop, K. N., & Varacallo, M. A. (2023). Anatomy, shoulder and upper limb, dorsal scapular nerve. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459343/